Page 1
Page 2
Page 3
Page 4
Page 5
Page 6
Page 7
Page 8
Page 9
Page 10
Page 11
Page 12
Page 13
Page 14
Page 15
Page 16
Page 17
Page 18
Page 19
Page 20
Page 21
Page 22
Page 23
Page 24
Page 25
Page 26
Page 27
Page 28
Page 29
Page 30
Page 31
Page 32
Page 33
Page 34
Page 35
Page 36
Page 37
Page 38
Page 39
Page 40
Page 41
Page 42
Page 43
Page 44
Page 45
Page 46
Page 47
Page 48
Page 49
Page 50
Page 51
Page 52
Page 53
Page 54
Page 55
Page 56
Page 57
Page 58
Page 59
Page 60
Page 61
Page 62
Page 63
Page 64
Page 65
Page 66
Page 67
Page 68
Page 69
Page 70
Page 71
Page 72
Page 73
Page 74
Page 75
Page 76
22ALTERNATIVETHERAPIESsepoct2011VOL.17NO.5Tkareasof9nowledgeandexperience.Pilottestingandcontentvalidationwithacommunity-basedsamplefurtherreMnedtheDMPI.Thesamplewaspurposefullyrecruitedtovaryonseveraldemographicfeaturessoastogainbroadfeedbac9onwhethertheDMPIwasreadilyunderstandableandappropriatelycapturedbarrierstomeditation.SimilartotheEPthepilottestparticipantsassiduouslycarriedouttheirrespon-sibilitiesprovidingthoughtfulcommentaryandaddingtotheclarityoftheDMPI.Theirfeedbac9ledtoeliminationoffiveitemsrepresentinga23reductioninthelengthoftheDMPIfrom22itemsto17items.Whilethissizablereductionseemeddraconianatthetimetherespectableindicatorsofinternalcon-sistencyattainedwiththelargersampleof150supportsthepro-cessatleastatthisinitialphaseofpsychometrictesting.Cronbachx19scoefMcientaforthe17-itemDMPIis0.87indicat-ingtheitemsholdtogetherinacoherentway.Theexceptionisitem8x1cPrayerismyformofx0meditationx1dwhichhadanitem-in-strumentcorrelationofx130.08demonstratingnegligiblecontribu-tiontotheinstrumentasawhole.Thedecisionwasmadetoretainitem8toseehowitperformswithlargermorediversesamples.The108retestparticipantsshowednostatisticallysigniM-cantdifferencebygenderorbaselineDMPItotalscoresfromthosewhodidnotcompletearetesthowevernoncompleterswereonaverageyoungerthancompleters.ThismayreNecttheincreasedli9elihoodthatyoungerparticipantswereemployedoutsidethehomeandorhadotherdependentsandconsequent-lywouldhavegreaterdifMcultyschedulingaretestdate.TheICCwasusedtocomparetotalDMPIscoresattwotimepointsbase-lineandretest1wee9hence.TheICCcomplementsCronbachx19scoefficientaintestingreliabilityandideallythetwotestsshouldprovidesimilarresults.Ourtestresultswerecomplemen-taryandconMrmatorya0.87ICC0.86CI0.82-0.90.BasedontheTPBwehypothesizedtheDMPIwouldcorre-latewithBFIandCRAeachofwhichwaspurportedtomeasuredifferentcomponentsoftheTPB.BFIandCRAdonotmeasurethesameconstructastheDMPInordotheymeasureaplannedbehaviorbutrathervariablesleadingtoaplannedbehaviorthereforeweexpectedthecorrelationswouldbepositiveyetmodest.ThoughestimationofconstructvalidityasassessedbythismethodconMrmedthehypothesizedrelationshipswithsta-tisticallysigniMcantpositivecorrelationstheresultsmustbeinterpretedwithcaution.FuturestudywithconMrmatoryfactoranalysiswillallowustoestimateconstructvaliditybytestingahypothesisabouttherelationshipbetweentheitemsandtheirunderlyinglatentconstructsnamelythecontentdomains.ItshouldbenotedthattheDMPIwasdesignedtoidentifybarrierstomeditationattheexclusionofidentifyingfacilitators.Whenoneloo9satdeterminantstoaplannedhealthbehaviorbarriersandfacilitatorsareoftenequallyimportant.24Byexclud-ingfacilitatorstomeditationweareneitherignoringnordimin-ishingtheirimportance.RatherwithoursamplesizeconstrainedbyresourcesitbecameapparentthatwewouldhavedatasufM-cientonlytointerpretpsychometrictestingofaninstrumentaddressingasingleconstruct.ReliabilitytestingoftheDMPIinvolvedretestingpartici-pantsafter1wee9.Therelativelymodestwindowbetweentest-ingwaschoseninanattempttominimizevariabilityinresponsessecondarytotherapidlychangingcircumstancesofbeingafami-lycaregiver.Withonly1wee9betweentestandretesthowevertheris9forx1cpracticeeffectx1disincreased.25ThesampleforthisstudyispredominantlywhiteeducatedwomenfromthenortheasternUnitedStateswhoareinthehigh-lystressfulroleofcaringforanadultwithcancer.Thereforegen-eralizabilityoftheresultsislimited.FuturestudyshouldexposetheDMPItootherpopulationsinothersettings.CONCLUSIONSHigh-qualityscientiMcevidenceformeditationx19sefMcacyislimitedinpartbecausemanyresearchstudieshavebeenunder-minedbysmallsamplesizesthatlimitstatisticalpowersothataneffectisnotidentiMedwhenitmightinfactbepresent.Highattritionhasalsocharacterizedmanymeditationstudiesandthisshortcominghasthepotentialtointroducebiaswhenmiss-ingdataisnothandledproperly.Descriptivewor9identifyingpotentialbarrierstomeditationpracticewillprovidethestruc-turetoframemeditationinterventionsinanaccessibleform.Forexampleifmanymembersofatargetpopulationidentifyx1cIcanx19tsitstilllongenoughtomeditatex1dasabarrierresearcherscandesignrecruitmentmaterialsthatassurepotentialpartici-pantsthattheycanwal9orliedowntomeditate.Fromastatisti-calstandpointtheDMPImayhelpresearchersdifferentiatebetweenmeditationinterventionrespondersandnonrespondersaswellascompletersandnoncompleters.Ideallybyidentifyingandaddressingbarriersrecruitmentwillbeoptimizedattritionminimizedandinterpretationofstudyresultsmaximized.ThedevelopmentoftheDMPIaspresentedhereisonestepintheprocesstopromotemethodologicrigorinmeditationresearch.PreliminarydataindicatethecurrentversionoftheDMPIisapsychometricallysoundinstrumentthatisreadytobetestedwithlargerandmorediversesamples.TheDMPIisnotintendedasascreeningtooltoexcludefrommeditationresearchthoseindividualswhohaveahighnumberofbarrierstomeditation.Ratherbyidentifyingandaddressingbarriersearlymeditationinterventionscanbecomemoreinclusiveofalargersegmentofthepopulation.UltimatelytheDMPImayhelpadvancethescienceofmind-bodymedicineandallowforevidence-drivenclinicaldecisionsaboutthepossi-blesalutatoryeffectsofmeditation.AcknowledgmentsSinceregratitudeisextendedtotheExpertPanelmembersJohnAstinPhDBarrieCassilethPhDBethRothMSNSharonSalzburgandShinzenYoung.ThisprojectwassupportedbytheNationalCenterforComplementaryandAlternativeMedicineF31AT003535MindandLifeInstituteFranciscoJ.VarelaContemplativeScienceGrantAwardandEvelynAndersonstudentresearchaward.DrVanNesswassupportedinpartbyfundingfromtheClaudeD.PepperOlderAmericansIndependenceCenterattheYaleUniversitySchoolofMedicine2P30AG021342-06.x0REFERENCESx01.AstinJAShapiroSLEisenbergDMForyskL.Mind-bodymedicinestateofthesci-enceimplicationsforpractice.Jx0Amx0Boardx0Famx0Pract.2003162131-147.DeterminantsofMeditationPracticeInventory